Preservation of reserve for bilateral cysts
When operating on both ovaries, the main thing is to preserve maximum healthy tissue and blood supply: the capsules are removed with minimal coagulation, the beds are sutured, which reduces the loss of follicles. Before surgery, ovarian reserve (AMH, number of follicles) is assessed; For women planning to become pregnant, the possibility of egg cryopreservation in case of severe damage is discussed. All removed tissues undergo histology, and if in doubt, undergo urgent histology. For endometriomas, anti-relapse therapy is prescribed after surgery; when planning pregnancy, active conception or IVF in the coming months.
Indications
- cysts and benign tumors of the ovaries of large sizes (more than 10–15 cm), not subject to laparoscopy;
- suspicion of a borderline or malignant tumor - the need for revision and urgent histology;
- pronounced adhesions, repeated operations, concomitant diseases that exclude laparoscopy;
- giant cystomas involving the omentum and stretching of the abdominal wall.
Open surgery for cysts
Laparotomy for ovarian cysts is used today for very large and suspicious formations: open access allows you to remove the entire tumor without rupture (essentially in case of possible malignancy), examine and palpate all organs, perform an urgent histological examination and, if necessary, expand the volume. In young women, ovarian tissue is preserved as much as possible; In case of a unilateral tumor, the second ovary must be examined. The bikini incision is sutured cosmetically.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
